How To Detect Menopause If You Are On the Birth Control Pill: A Breakthrough

A study from the Family Planning Association of Hong Kong published in a recent Contraception begins to answer a question that has confounded gynecologists for over 50 years. If a woman in on birth control pills, how can she tell if she has gone through menopause? Simplistic answers are to stop the birth control pills, wait until their effects wear off and see if a woman then goes without a period for the requisite year by which menopause would be defined. Waiting a year for an answer is a clearly ludicrous solution and one that puts women at risk without the benefit of their effective contraception for those who have not yet crossed over into menopause. When women are not on their pills they have symptoms of menopause, an ultrasound with no evidence of egg development, and some classically known blood level changes. Their FSH levels rise and their estrogen levels decrease. But on birth control pills these tests are not particularly accurate, even if performed in the few days a month a woman is not taking pills. Other women stop getting their period for reasons connected with being on the pill and nothing to do with being menopausal. We know there are other substances secreted by the ovary, so the gynecologist in Hong Kong decided to explore what other tests might give us a better answer. The ovary produces an egg from a follicle, the follicle is built of cells called the granulose cells in the early stages. These cells secrete a unique hormone called the Anti-mullerian hormone (AMH). Infertility physicians have been ordering these tests for awhile as the levels are decreased in premature menopause and extra high in women with polycystic ovaries. These researchers looked at AMH levels in women before and after and during the use of birth control and found that they are not affected by taking oral contraceptives! This may then be the best test of whether women are in menopause as they get older and are still taking the birth control pills.


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